Leave

This form is the first step in requesting paid or unpaid leave time. When the form is completed, you will receive an email. Either print it & give it to your supervisor for approval, or forward it to your supervisor.

Staff Calendar (60 Days)

Staff Calendar (360 Days)

Leave Request Form

First Name *

Middle Name

Last Name *

Email Address *

What type of leave are you requesting?: *

Beginning Date: *

Beginning Time *

Ending Date: *

Ending Time *

Hours of paid leave requested:

Hours of unpaid leave requested:

*For emergency leave* (You must specify a reason & emergency leave must be approved by the director):

This area to be completed by supervisor:

1. Please indicate yes or no:

______ I have checked to see that the employee has sufficient paid leave time to cover this request.

______ Department is adequately covered with existing staff, sub not needed.

2. I cannot approve leave for the reason below.

___ Employee does not have enough paid leave earned...requires Director's approval
____ Another employee is on leave from this department at this time.
____ Substitute needed...requires Scheduling Supervisor's approval

Supervisor Signature _________________________________

Date ________________

This area to be completed by Scheduling Supervisor.

__________________________ (substitute is available to work).

Scheduling supervisor's signature___________________________

Date:___________

This section to be completed by the Library Director.

Request:

___ Approved

___ Disapproved

Director's Signature: ______________________________

Please do not fill in this field.